Monday, September 30, 2013

The Conservative government is launching a $1.3-billion free market in medical marijuana this Tuesday, eventually providing an expected 450,000 Canadians with quality weed.

Health Canada is phasing out an older system on Monday that mostly relied on small-scale, homegrown medical marijuana of varying quality, often diverted illegally to the black market.

In its place, large indoor marijuana farms certified by the RCMP and health inspectors will produce, package and distribute a range of standardized weed, all of it sold for whatever price the market will bear. The first sales are expected in the next few weeks, delivered directly by secure courier.

"We're fairly confident that we'll have a healthy commercial industry in time," Sophie Galarneau, a senior official with the department, said in an interview.

Health Canada is placing no limits on the number of these new capital-intensive facilities, which will have mandatory vaults and security systems. Private-dwelling production will be banned. Imports from places such as the Netherlands will be allowed.

Already 156 firms have applied for lucrative producer and distributor status since June, with the first two receiving licences just last week.

The old system fostered only a cottage industry, with 4,200 growers licensed to produce for a maximum of two patients each. The Mounties have complained repeatedly these grow-ops were often a front for criminal organizations.

The next six months are a transition period, as Health Canada phases out the old system by March 31, 2014, while encouraging medical marijuana users to register under the replacement regime and to start buying from the new factory-farms.

There are currently 37,400 medical marijuana users recognized by the department, but officials project that number will swell more than 10-fold, to as many as 450,000 people, by 2024.

The profit potential is enormous. A gram of dried marijuana bud on the street sells for about $10 and Health Canada projects the legal stuff will average about $7.60 next year, as producers set prices without interference from government.

Chuck Rifici of Tweed Inc. has applied for a licence to produce medical weed in an abandoned Hershey chocolate factory in hard-scrabble Smiths Falls, Ont.

Rifici, who is also a senior adviser to Trudeau, was cited in a Conservative cabinet minister's news release Friday that said the Liberals plan to "push pot," with no reference to Health Canada's own encouragement of marijuana entrepreneurs.

Rifici says he's trying to help a struggling community by providing jobs while giving suffering patients a quality product.

"There's a real need," he said in an interview. "You see what this medicine does to them."

Tweed Inc. proposes to produce at least 20 strains to start, and will reserve 10 per cent of production for compassionate, low-cost prescriptions for impoverished patients, he says.

Patients often use several grams a day to alleviate a wide range of symptoms, including cancer-related pain and nausea. They'll no longer be allowed to grow it for themselves under the new rules.

Revenues for the burgeoning new industry are expected to hit $1.3-billion a year by 2024, according to federal projections. And operators would be favourably positioned were marijuana ever legalized for recreational use, as it has been in two American states.

Eric Nash of Island Harvest in Duncan, B.C., has applied for one of the new licences, banking on his experience as a licensed grower since 2002 in the current system.

"The opportunity in the industry is significant," he said in an interview.

"We'll see a lot of moving and shaking within the industry, with companies positioning. And I think we'll see some mergers and acquisitions, strategic alliances formed."

"It'll definitely yield benefits to the consumers and certainly for the economy and society in general."

Veterans Affairs Canada currently pays for medical marijuana for some patients, even though the product lacks official drug status. Some provinces are also being pressed to cover costs, as many users are too sick to work and rely on welfare.

Health Canada currently sells medical marijuana, produced on contract by Prairie Plant Systems, for $5 a gram, and acknowledges the new system will be more expensive for patients.

But Galarneau says competition will help keep prices in check.

"We expect that over time, prices will be driven down by the free market," she said. "The lower price range will likely be around $3 a gram. ... It's hard to predict."

Saskatoon-based Prairie Plant Systems, and its subsidiary CanniMed Ltd., were granted the first two licences under the system and are already advertising their new products on the web.

Friday, September 27, 2013

Dealing with a medical condition is often difficult. Connecting with others who are going through the same thing can make a world of difference. HealthBoards.com is where you can make those connections. HealthBoards provides a unique one-stop support group community offering over 200 message boards on various diseases, conditions, and health topics. The HealthBoards community is one of the largest and most dynamic on the Web, with over 10 million monthly visitors, 850,000 registered members, and over 4.5 million messages posted. HealthBoards was rated as one of the top 20 health information websites by Consumer Reports Health WebWatch.

Thursday, September 26, 2013

Chronic pain is a major public health problem, and treatments are limited. More research is needed to fully understand how acute pain evolves into chronic pain, and who will transition from acute to chronic pain.

The Blueprint Grand Challenge on Chronic Pain seeks to shed light on the molecular, cellular and circuit-level changes – or neuroplasticity – underlying chronic pain. A key element of the program is to form research collaborations between experts on pain and experts on neuroplasticity.

Mechanisms of Support

The Grand Challenge on Chronic Pain supports research through:

Multi-PI R01 grants focused on understanding the maladaptive changes that occur during the transition from acute to chronic pain.

Competitive revisions that propose a collaborative, one year pilot study or a new specific aim associated with an active NIH grant. These initial studies are expected to lead to long term collaborations focused on chronic pain.

Chronic pain is a major medical problem, affecting as many as 100 million Americans, robbing them of a full sense of well-being, disrupting their ability to work and earn a living, and causing untold suffering for the patient and family. This condition costs the country an estimated $560-635 billion annually—a staggering economic burden [1]. Worst of all, chronic pain is often resistant to treatment. NIH launched the Grand Challenge on Chronic Pain [2] to investigate how acute pain (which is part of daily experience) evolves into a chronic condition and what biological factors contribute to this transition.

But you may wonder: what, exactly, is the difference between acute and chronic pain?

Acute pain is an intensely unpleasant sensation transmitted by the nervous system to alert you to a real or impending injury—like a bruise, cut, or burn—or an infection like a toothache. It's a warning that something's wrong with your body, and that you need to take action. It can trigger you to remove your hand from a hot stove or to get rid of that pair of shoes that make your feet hurt every time you wear them. Pain is a powerful protective mechanism: those who cannot feel it, whether from a genetic condition or from an acquired disease of peripheral nerves like leprosy, suffer very serious consequences. But normally, acute pain is short lived—when the injury has healed, the pain is gone.

But in some situations, this acute pain becomes chronic, persisting for months or even years. In many instances that happens because the physiological condition is ongoing and unresolved—as in cancer or arthritis. But in some instances, the pain doesn't appear to be caused by any disease, injury, or detectable damage to the nervous system [3]. That pain is just as real to the person suffering from it, though it is referred to as psychogenic pain.

We currently treat chronic pain with a variety of therapies, including medications, electrical stimulation, and surgery. Medications range from relatively mild over-the-counter drugs like aspirin to more powerful prescription drugs like Vicodin™ or Percocet™, which act on the brain and spinal cord to relieve pain. But these powerful narcotic drugs can cause serious side effects. They also carry the risk of addiction.

We believe that one key to developing better treatments is to identify signs that acute pain is likely to become chronic. By discovering such markers, we can personalize the treatment of pain. We could provide more aggressive treatments for those at high risk for chronic pain and minimal treatment for those likely to bounce back quickly. This would also help to reduce the risk of abuse and addiction to painkillers.

Here's one example. We're funding efforts to understand how the brain perceives a very common problem: back pain. Are there are biological markers that signal which patients' pain will evolve into a more chronic form? Already, promising new fMRI brain imaging studies can predict which people will suffer from chronic pain after the acute phase [4].

We're also looking into whether acute pain causes brain changes in certain people that might enhance pain sensitivity and lead to chronic pain. People coping with chronic pain often suffer from several conditions simultaneously—fibromyalgia and temporomandibular joint disorders or irritable bowel syndrome, for example. Is there some common mechanism?

We know there's a significant difference in the way children, adults, and the elderly react to pain. A paper cut, for example, might cause your 6 year old to erupt in a fountain of tears, whereas most adults would just brush the injury aside. Is that because our wiring changes as we age? It's an intriguing question, and one that we hope to answer.

We're also investigating the use of complementary and alternative methods—like massage, acupuncture, herbal remedies, meditation, and yoga—to treat pain separately, or in addition to traditional analgesic treatments [5, 6]. As part of the Grand Challenge on Chronic Pain, we hope to understand the causes of chronic pain better—and ultimately to alleviate the suffering of millions.

A saline injection in the spine could be more effective than steroids for treating lower back pain, a new study has revealed.

Spinal pain is a leading cause of disability in the industrialised world and epidural steroid injections - the most common nonsurgical treatment - have been the standard treatment for more than 50 years.

Yet the alternative spinal injection in the space around the spinal cord may provide better relief than steroids which can have adverse side effects.

Steroids raise blood sugar in diabetic back patients, slow the healing of wounds and accelerate bone disease in older women, the Johns Hopkins University study found.

Professor of Anaesthesiology Steven Cohen at the U.S. university said: 'Just injecting liquid into the epidural space appears to work.

'This shows us that most of the relief may not be from the steroid, which everyone worries about.'

The research was prompted when more than 740 people in 20 U.S. states became ill with fungal meningitis and 55 people died after getting epidural injections of contaminated steroids last year.

Although better oversight might reduce that risk, patients can only get a limited number of steroid injections each year, even if their pain returns.

Professor Cohen said it was too soon to recommend that patients stop receiving epidural steroids, but added that their analysis also suggests that smaller steroid doses can be just as beneficial.

Fellow researcher Dr Mark Bicket said larger scale studies were needed to determine whether steroid alternatives can be just as helpful for back pain patients.

He said: 'Our evidence does support the notion that, for now, reducing the amount of steroids for patients at risk may be advisable.'

The review covered medical records of 3,641 patients from 43 studies conducted in October 2012 and compared epidural steroid injections to other sorts of epidural and intramuscular injections.

Professor Cohen said the new analysis suggested that decades of mixed results of research on epidural steroid injections may have been due to the use of saline or anaesthetic injections as the comparison 'placebo' treatment.

He said: 'It's likely that those studies were actually comparing two treatments, rather than placebo versus treatment. Researchers may be wasting millions of dollars and precious time on such studies.'

The findings are published in the latest edition of the journal Anaesthesiology.

Nearly everyone has experienced bodily pain, yet describing it is notoriously difficult. In 1930, Virginia Woolf lamented that even a schoolgirl, "when she falls in love, has Shakespeare and Keats to speak her mind for her; but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry".

Is pain really so difficult to articulate? Or can it actually generate creative expression? If so, what do these narratives tell us about the meaning of pain? Some believe it has the power to purge sin; others interpret it as an unjust punishment. Pain can even be regarded as intrinsic to achievement - 'no pain, no gain'.

This unique two-day symposium brought together some of the liveliest and most widely respected creative and scholarly minds to prod, probe and discuss profound questions about the relationship between body, mind and culture. How and why do we give meaning to bodily pain?

'Pain and its Meanings' was a collaboration between the Birkbeck Pain Project and Wellcome Collection. Please see the Birkbeck Pain Project website for audio and texts related to the event.

This issue of 19, guest edited by Louise Hide, Joanna Bourke, and Carmen Mangion, examines the meaning of pain - for sufferers, physicians, and other witnesses - in the nineteenth century. Articles by social and cultural historians, and by literary scholars, discuss the implications of shifting discourses in personal narratives, in religious communities, and in philosophical, medical, and psychiatric texts. Analysing language in the diverse theories of the period, this issue extends and deepens our understanding of the complex interaction between the body, mind, and culture in order to gain insight into the ever-changing subjective experience of pain.

The Birkbeck Pain Project examines narratives of bodily pain produced from the mid-eighteenth century to the present day. Funded by the Wellcome Trust, the three-year project, led by Professor Joanna Bourke, is based at the Department of History, Classics, and Archaeology.

• The story of pain and suffering since the eighteenth century• Addresses the big questions about the experience and nature of suffering - and how to respond to it• Charts how our understanding of pain has changed completely over the last three centuries - from positive function to ultimate evil• A fascinating investigation for the 21st century reader into how we have coped with suffering in the past - both our own suffering and that of the ones we love

Everyone knows what is feels like to be in pain. Scraped knees, toothaches, migraines, giving birth, cancer, heart attacks, and heartaches: pain permeates our entire lives. We also witness other people - loved ones - suffering, and we 'feel with' them.

It is easy to assume this is the end of the story: 'pain-is-pain-is-pain', and that is all there is to say. But it is not. In fact, the way in which people respond to what they describe as 'painful' has changed considerably over time. In the eighteenth and nineteenth centuries, for example, people believed that pain served a specific (and positive) function - it was a message from God or Nature; it would perfect the spirit. 'Suffer in this life and you wouldn't suffer in the next one'. Submission to pain was required. Nothing could be more removed from twentieth and twenty-first century understandings, where pain is regarded as an unremitting evil to be 'fought'.

Focusing on the English-speaking world, this book tells the story of pain since the eighteenth century, addressing fundamental questions about the experience and nature of suffering over the last three centuries. How have those in pain interpreted their suffering - and how have these interpretations changed over time? How have people learnt to conduct themselves when suffering? How do friends and family react? And what about medical professionals: should they immerse themselves in the suffering person or is the best response a kind of professional detachment?

As Joanna Bourke shows in this fascinating investigation, people have come up with many different answers to these questions over time. And a history of pain can tell us a great deal about how we might respond to our own suffering in the present - and, just as importantly, to the suffering of those around us.

Monday, September 16, 2013

A girl who does not feel physical pain has helped researchers identify a gene mutation that disrupts pain perception. The discovery may spur the development of new painkillers that will block pain signals in the same way.

People with congenital analgesia cannot feel physical pain and often injure themselves as a result – they might badly scald their skin, for example, through being unaware that they are touching something hot.

By comparing the gene sequence of a girl with the disorder against those of her parents, who do not, Ingo Kurth at Jena University Hospital in Germany and his colleagues identified a mutation in a gene called SCN11A.

This gene controls the development of channels on pain-sensing neurons. Sodium ions travel through these channels, creating electrical nerve impulses that are sent to the brain, which registers pain.

Blocked signals

Overactivity in the mutated version of SCN11A prevents the build-up of the charge that the neurons need to transmit an electrical impulse, numbing the body to pain. "The outcome is blocked transmission of pain signals," says Kurth.

To confirm their findings, the team inserted a mutated version of SCN11Ainto mice and tested their ability to perceive pain. They found that 11 per cent of the mice with the modified gene developed injuries similar to those seen in people with congenital analgesia, such as bone fractures and skin wounds. They also tested a control group of mice with the normal SCN11A gene, none of which developed such injuries.

The altered mice also took 2.5 times longer on average than the control group to react to the "tail flick" pain test, which measures how long it takes for mice to flick their tails when exposed to a hot light beam. "What became clear from our experiments is that although there are similarities between mice and men with the mutation, the degree of pain insensitivity is more prominent in humans," says Kurth.

The team has now begun the search for drugs that block the SCN11Achannel. "It would require drugs that selectively block this but not other sodium channels, which is far from simple," says Kurth.

Completely unexpected

"This is a cracking paper, and great science," says Geoffrey Woods of the University of Cambridge, whose team discovered in 2006 that mutations in another, closely related ion channel gene can cause insensitivity to pain. "It's completely unexpected and not what people had been looking for," he says.

Woods says that there are three ion channels, called SCN9A, 10A and 11A, on pain-sensing neurons. People experience no pain when either of the first two don't work, and agonising pain when they're overactive. "With this new gene, it's the opposite: when it's overactive, they feel no pain. So maybe it's some kind of gatekeeper that stops neurons from firing too often, but cancels pain signals completely when it's overactive," he says. "If you could get a drug that made SCN11A overactive, it should be a fantastic analgesic."

"It's fascinating that SCN11A appears to work the other way, and that could really advance our knowledge of the role of sodium channels in pain perception, which is a very hot topic," says Jeffrey Mogil at McGill University in Canada, who was not involved in the new study.

Wednesday, September 11, 2013

Like truth and beauty, pain is subjective and hard to pin down. What hurts one moment might not register the next, and our moods and thoughts color the experience of pain. According to a report in April in the New England Journal of Medicine, however, researchers may one day be able to measure the experience of pain by scanning the brain—a much needed improvement over the subjective ratings of between one and 10 that patients are currently asked to give.

Led by neuroscientist Tor Wager of the University of Colorado at Boulder, researchers used functional MRI on healthy participants who were given heated touches to their arm, some pleasantly warm, others painfully hot. During the painful touches, a scattered group of brain regions consistently turned on. Although these regions have been previously associated with pain, the new study detected a striking and consistent jump in their activity when people reported pain, with much greater accuracy than previous studies had attained. This neural signature appeared in 93 percent of subjects reporting to feel painful heat, ramping up as pain intensity increased and receding after participants took a painkiller.

The researchers determined that the brain activity specifically marked physical pain rather than a generally unpleasant experience, because it did not emerge in people shown a picture of a lover who had recently dumped them. Although physical pain and emotional pain involve some of the same regions, the study showed that fine-grained differences in activation separate the two conditions.

A brain-based marker of pain might someday help doctors assist people who have difficulties communicating, such as the very young or victims of stroke. Yet Wager does not see this neural signature as a pain "lie detector." "There are many psychological and physiological ingredients that go into a person's report of pain, and we've discovered just one ingredient here," he says. Many states of brain activity very likely give rise to pain, Wager adds, "pain is not just one thing."